Some doctors still mistaken on IUD safety

NEW YORK (Reuters Health) - Many U.S. doctors and other health providers may have mistaken beliefs about the safety of IUD contraceptives, a new government study suggests.

"IUDs are safe for nulliparous women," said the Centers for Disease Control and Prevention's (CDC's) Crystal P. Tyler, who led the study, referring to women who've never given birth. "And IUDs are as effective as sterilization, but they're a reversible form of contraception."

IUDs, or intrauterine devices, are implanted in the uterus, where they release small amounts of either copper or the hormone progestin to prevent pregnancy.

In the U.S., IUDs are much less popular than birth control pills and condoms for contraception. But groups like the American College of Obstetricians and Gynecologists (ACOG) say IUDs are highly effective, and more women should be aware of that.

One of the issues may be doctors' beliefs about IUD safety. In the new study, researchers at the CDC found that 30 percent of health providers they surveyed doubted the safety of IUDs for women who'd never given birth.

When IUDs first came out, there were concerns that they might raise the risk of pelvic infection and jeopardize women's future fertility. So the original IUD labeling said the devices were contraindicated for women who'd never had children.

But it's now known that IUDs do not carry those risks, said Tyler. And unlike birth control pills and condoms -- which require "perfect" use -- IUDs are put in place, then can be "forgotten," Tyler told Reuters Health.

The hormonal IUD, sold under the brand-name Mirena, can prevent pregnancy for five years, while the copper version, sold as ParaGard, is effective for about 10 years.

A recent study found that 0.8 percent of U.S. women using a copper IUD had an unplanned pregnancy within a year. The rate for those on the hormonal IUD was 0.2 percent.

In contrast, about nine out of every 100 women on birth control pills can expect to have an unintentional pregnancy in a year -- owing largely to imperfect use. With condoms, about two percent of women will become pregnant, but that's only if a couple uses them correctly, every time they have sex.

It's not completely clear why some doctors still have doubts about IUD safety.

But, Tyler said, "I think it may have to do with training." In this study, providers who never had training in IUD placement were more likely to have safety concerns about the devices.

IUDS NOT POPULAR

The findings, which appear in the journal Obstetrics & Gynecology, are based on a survey of almost 2,000 U.S. health providers. The group included obstetrician/gynecologists and family doctors, as well as nurses and physician assistants working at family planning clinics.

Overall, about 30 percent either thought IUDs were unsafe for women who'd never given birth, or said they were unsure of their safety.

And those providers were, not surprisingly, less likely to implant IUDs. Compared with other providers, they were six times more likely to say they "infrequently" provided the devices to women who'd never had a baby.

But IUDs were not a popular form of contraception in general. More than 60 percent of all providers in the survey said they only occasionally provided them -- often because of "patient preference."

"Unfortunately, the U.S. is a little behind other countries in IUD use," Tyler said. "Many women don't really know they're out there."

With more health-provider education, that might change, according to Tyler.

In 2010, the CDC released national guidance on the safety of different contraceptives, including IUDs. The hope, Tyler said, is that the guides will help clear up health providers' lingering misconceptions.

SIDE EFFECTS AND COSTS

Like other contraceptives, IUDs can have unwanted side effects.

The Mirena IUD may cause menstrual irregularities. But it generally makes periods lighter, which is why it is also approved as a treatment for heavy bleeding. The ParaGard IUD has the opposite effect: menstrual bleeding and cramping can increase, though that may go away over time.

Another issue is price, which may also factor into the low rates of IUD use in the U.S.

The upfront cost of the Mirena device itself has gone up over the years and is now nearly $800. The ParaGard price tag is about $500. Then there are the doctor's charges.

On the other hand, since the devices last for years, those costs could become worthwhile over time.

Birth control pills, for instance, cost anywhere from about $10 to $50 a month, depending on whether a woman uses generic or brand-name pills.